Patient record
| Payer | Plan | Member ID | Group ID | Relationship | Primary |
|---|---|---|---|---|---|
| PRIVATE | PR | Secondary |
PSB F6 E1 · Manual exception
Routine B1 processing uses active coverage already on file and does not call E1. Use this manual check only when eligibility is uncertain. Results are coverage proposals; applying coverage remains a separate user decision.
| Result | Mode | Actor | Response | Recorded |
|---|---|---|---|---|
| No E1 eligibility evidence recorded. | ||||
| Medication | Sig | Qty / days supply | Refills remaining | Last fill | Next due | Status |
|---|---|---|---|---|---|---|
| DAPSONE 100MG TAB 100MG 49938010130 · Rx 29350 |
— | 45 / 45 days | 0 of 0 | 2018-02-12 | 2018-03-29 | Completed |
| SPIRONOLACT 25MG TAB 25MG 00378214601 · Rx 29348 |
— | 25 / 25 days | 2 of 2 | 2018-02-12 | 2018-03-09 | Overdue |